Changes to Local Coverage Determinations (LCD)

April 2015

This information was provided by NGS,  the Medicare Administrative Contractor (MAC) for Connecticut and other New England states.

Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography – Supplemental Instructions Article (A48362)

The following coding guideline was revised for CPT codes 76641 and 76642:

For dates of service on or after January 1, 2015, the replacement codes are 76641 and 76642. If performed bilaterally, a modifier 50 may be reported with CPT code 76641 or 76642.

 Cardiac Catheterization and Coronary Angiography (L26880)

The Indications section was revised to clarify coverage for patients undergoing non-coronary cardiac surgical procedures by adding this example: (e.g., aortic or mitral valve surgery when not requiring left heart catheterization). An asterisk note was added for ICD-9 codes 793.2 and 794.39 on reporting this situation.

Grafix® – Related to LCD L26003 (A53933)

Corrected ABI to reflect adequate circulation between > 0.70 and <1.20.

Intravenous Immune Globulin (IVIG) – Related to LCD L25820 (A47381)

Based on a reconsideration request, the first two bullets (prior treatment with corticosteroids and splenectomy; and duration of illness less than 6 months) under the indication for chronic refractory ITP have been removed. The indication for chronic refractory ITP has been changed from:

IVIG is indicated for chronic ITP only when all of the following conditions are met:

to

IVIG is indicated for chronic ITP when the following conditions are met:

The following sources of information have been added:

European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of paraproteinemic demyelinating neuropathies. Report of a Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Societyfirst revision. J Peripher Nerv Syst. 2010 Sep;15(3):185-95. doi: 10.1111/j.1529-8027.2010.00278.x.

Koski CL, Baumgarten M, Magder LS, et al. Derivation and validation of diagnostic criteria for chronic inflammatory demyelinating polyneuropathy. J Neurol Sci. 2009 Feb 15;277(1-2):1-8,doi:10.1016/j3jns.2008,11.015.

The FDA label information has been added to the “Sources of Information” section.

Nerve Conduction Studies and Electromyography (L33386)

LCD revised to change wording from screening to not medically necessary under the sections about performing nerve conduction studies alone and testing for polyneuropathy of diabetes or endstage renal disease. In addition, ICD-9 codes 374.31 and 374.32 were added to the list of diagnoses payable for neuromuscular junction testing (CPT code 95937).

Non-covered Services (L32456)

The LCD was returned for comment in the JK and J6 MAC jurisdictions, from October 30, 2014 to December 13, 2014. Non-coverage provisions and CPT codes were added for Carotid Intima Media Thickness (CIMT) and ST2 Assay. Sources reviewed as the basis for non-coverage were added to the LCD including those received during the comment period.

Removal of Benign Skin Lesions (A54096)

The new educational article provides documentation requirements and coding instructions for non-cosmetic removal of benign skin lesions, effective for services rendered on or after 04/01/2015.

Speech-Language Pathology (L27404)

Added ICD-9-CM codes 478.75, 530.81 and 786.2 to the “ICD-9-CM Codes that Support Medical Necessity” section.

 

Retired LCDs and Articles

Removal of Benign Skin Lesions (L27362) and Removal of Benign Skin Lesions – Supplemental Instructions Article (A47397)

The LCD and Article have been retired, effective 03/31/2015.

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